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Edwards JN, Whitney MA, Smith BB, Fah MK, Buckner Petty SA, Durra O, Sell-Dottin KA, Portner E, Wittwer ED, Milam AJ. The role of methadone in cardiac surgery for management of postoperative pain. BJA Open 2024; 10:100270. [PMID: 38560623 PMCID: PMC10978480 DOI: 10.1016/j.bjao.2024.100270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
Background This retrospective study evaluated the efficacy and safety of intraoperative methadone compared with short-acting opioids. Methods Patients undergoing cardiac surgery with cardiopulmonary bypass (n=11 967) from 2018 to 2023 from a single health system were categorised into groups based on intraoperative opioid administration: no methadone (Group O), methadone plus other opioids (Group M+O), and methadone only (Group M). Results Patients in Groups M and M+O had lower mean pain scores until postoperative day (POD) 7 compared with Group O after adjusting for covariates (P<0.01). Both Groups M and M+O had lower total opioid administered compared with Group O for all days POD0-POD6 (all P<0.001). The median number of hours until initial postoperative opioid after surgery was 2.55 (inter-quartile range [IQR]=1.07-5.12), 6.82 (IQR=3.52-12.98), and 7.0 (IQR=3.82-12.95) for Group O, Group M+O, and Group M, respectively. The incidence of postoperative complications did not differ between groups. Conclusions Intraoperative administration of methadone was associated with better pain control without significant side-effects after cardiac surgery.
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Affiliation(s)
- Jordan N. Edwards
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | | | - Bradford B. Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Megan K. Fah
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Omar Durra
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - Erica Portner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Erica D. Wittwer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Adam J. Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ, USA
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Clarke A, Boateng Evans A, Gabriel RA, Milam AJ. Race- and Ethnicity-Based Clinical Algorithms: Implications for Perioperative Medicine. Anesth Analg 2024; 138:1138-1141. [PMID: 38354055 DOI: 10.1213/ane.0000000000006477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Amelia Clarke
- From the Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Adjoa Boateng Evans
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, California
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California, San Diego, San Diego, California
| | - Adam J Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
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Kelava M, Milam AJ, Mi J, Alfirevic A, Grady P, Unai S, Elgharably H, McCurry K, Koprivanac M, Duncan A. Arterial Hyperoxemia During Cardiopulmonary Bypass Was Not Associated With Worse Postoperative Pulmonary Function: A Retrospective Cohort Study. Anesth Analg 2024; 138:1003-1010. [PMID: 37733624 PMCID: PMC10994185 DOI: 10.1213/ane.0000000000006627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Arterial hyperoxemia may cause end-organ damage secondary to the increased formation of free oxygen radicals. The clinical evidence on postoperative lung toxicity from arterial hyperoxemia during cardiopulmonary bypass (CPB) is scarce, and the effect of arterial partial pressure of oxygen (Pa o2 ) during cardiac surgery on lung injury has been underinvestigated. Thus, we aimed to examine the relationship between Pa o2 during CPB and postoperative lung injury. Secondarily, we examined the relationship between Pa o2 and global (lactate), and regional tissue malperfusion (acute kidney injury). We further explored the association with regional tissue malperfusion by examining markers of cardiac (troponin) and liver injury (bilirubin). METHODS This was a retrospective cohort study including patients who underwent elective cardiac surgeries (coronary artery bypass, valve, aortic, or combined) requiring CPB between April 2015 and December 2021 at a large quaternary medical center. The primary outcome was postoperative lung function defined as the ratio of Pa o2 to fractional inspired oxygen concentration (F io2 ); P/F ratio 6 hours following surgery or before extubation. The association between CPB in-line sample monitor Pa o2 and primary, secondary, and exploratory outcomes was evaluated using linear or logistic regression models adjusting for available baseline confounders. RESULTS A total of 9141 patients met inclusion and exclusion criteria, and 8429 (92.2%) patients had complete baseline variables available and were included in the analysis. The mean age of the sample was 64 (SD = 13), and 68% were men (n = 6208). The time-weighted average (TWA) of in-line sample monitor Pa o2 during CPB was weakly positively associated with the postoperative P/F ratio. With a 100-unit increase in Pa o2 , the estimated increase in postoperative P/F ratio was 4.61 (95% CI, 0.71-8.50; P = .02). Our secondary analysis showed no significant association between Pa o2 with peak lactate 6 hours post CPB (geometric mean ratio [GMR], 1.01; 98.3% CI, 0.98-1.03; P = .55), average lactate 6 hours post CPB (GMR, 1.00; 98.3% CI, 0.97-1.03; P = .93), or acute kidney injury by Kidney Disease Improving Global Outcomes (KDIGO) criteria (odds ratio, 0.91; 98.3% CI, 0.75-1.10; P = .23). CONCLUSIONS Our investigation found no clinically significant association between Pa o2 during CPB and postoperative lung function. Similarly, there was no association between Pa o2 during CPB and lactate levels, postoperative renal function, or other exploratory outcomes.
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Affiliation(s)
- Marta Kelava
- From the Departments of Cardiothoracic Anesthesiology
- Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| | - Adam J. Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Junhui Mi
- Departments of Quantitative Health Sciences
| | | | | | - Shinya Unai
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Kenneth McCurry
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Andra Duncan
- From the Departments of Cardiothoracic Anesthesiology
- Outcomes Research, Cleveland Clinic, Cleveland, Ohio
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Milam AJ, Youssef MR, Ugochukwu K, Habermann EB, Brennan E, Hanson KT, Raynor G, Porter SB, Harbell MW, Warner DO. Applying a Health Equity Lens to Intraoperative Opioid Administration and Postoperative Pain. Anesth Analg 2024:00000539-990000000-00815. [PMID: 38640079 DOI: 10.1213/ane.0000000000006968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Affiliation(s)
- Adam J Milam
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Mohanad R Youssef
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Kenechukwu Ugochukwu
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Elizabeth B Habermann
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida
| | - Emily Brennan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic
| | - Kristine T Hanson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic
| | - Gwendolyn Raynor
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Steven B Porter
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida
| | - Monica W Harbell
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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Porter SB, Martin-McGrew Y, Njathi-Ori C, Bruns DL, LeMahieu AM, Mantilla CB, Milam AJ, Ladlie BL. Postanesthesia Care Unit and Anesthetic Management Outcomes Among Patients Undergoing Noncardiac Surgery: Differences by Race and Ethnicity. J Perianesth Nurs 2024:S1089-9472(23)01060-2. [PMID: 38323973 DOI: 10.1016/j.jopan.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE To investigate the association of patient race and ethnicity with postanesthesia care unit (PACU) outcomes in common, noncardiac surgeries requiring general anesthesia. DESIGN Single tertiary care academic medical center retrospective matched cohort. METHODS We matched 1:1 1836 adult patients by race and/or ethnicity undergoing common surgeries. We compared racial and ethnic minority populations (62 American Indian, 250 Asian, 315 Black or African American, 281 Hispanic, and 10 Pacific Islander patients) to 918 non-Hispanic White patients. The primary outcomes were: the use of an appropriate number of postoperative nausea and vomiting (PONV) prophylactics; the incidence of PONV; and the use of a propofol infusion as part of the anesthetic (PROP). Secondary outcomes were: the use of opioid-sparing multimodal analgesia, including the use of regional anesthesia for postoperative pain control; the use of any local anesthetic, including the use of liposomal bupivacaine; the duration until readiness for discharge from the PACU; the time between arrival to PACU and first pain score; and the time between the first PACU pain score of ≥4 and administration of an analgesic. Logistic and linear regression were used for relevant outcomes of interest. FINDINGS Overall, there were no differences in the appropriate number of PONV prophylactics, nor the incidence of PONV between the two groups. There was, however, a decreased use of PROP (OR = 0.80; 95% CI: 0.69, 0.94; P = .005), PACU length of stay was 9.56 minutes longer (95% CI: 2.62, 16.49; P = .007), and time between arrival to PACU and first pain score was 2.30 minutes longer in patients from racial and ethnic minority populations (95% CI: 0.99, 3.61; P = .001). There were no statistically significant differences in the other secondary outcomes. CONCLUSIONS The rate of appropriate number of PONV prophylactic medications as well as the incidence of PONV were similar in patients from racial and ethnic minority populations compared to non-Hispanic White patients. However, there was a lower use of PROP in racial and ethnic minority patients. It is important to have a health equity lens to identify differences in management that may contribute to disparities within each phase of perioperative care.
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Affiliation(s)
- Steven B Porter
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL.
| | - Yvette Martin-McGrew
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Catherine Njathi-Ori
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Danette L Bruns
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | | | - Carlos B Mantilla
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Adam J Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ
| | - Beth L Ladlie
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
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Do AS, Khan MA, Ross L, Ravinsky R, Milam AJ, Lee SJ, Durra O, Johnson JP. Urgent Spinal Surgery in a Lateral Decubitus on a Patient with a Left Ventricular Assist Device on Full Anticoagulation: A Case Report. Cureus 2024; 16:e55266. [PMID: 38558610 PMCID: PMC10981535 DOI: 10.7759/cureus.55266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 04/04/2024] Open
Abstract
This case report aims to demonstrate the feasibility of performing spinal surgery in patients with a left ventricular assist device (LVAD), who are traditionally considered unsuitable candidates due to the need for anticoagulation and the challenges associated with the prone position. A case of a patient with an LVAD undergoing microdiscectomy in the left lateral decubitus position is presented. The procedure was carried out by a specialized interdisciplinary team with appropriate monitoring. The patient underwent the procedure safely, demonstrating that spinal surgery can be performed in patients with LVAD without reversing anticoagulation or resorting to the prone position. This approach mitigates the risk of thrombotic events and hemodynamic instability. This case study suggests that spinal surgery, specifically microdiscectomy, can be safely performed in patients with LVAD using the left lateral decubitus position. This finding has significant implications for patients who are unable to ambulate and therefore struggle to qualify for a heart transplant.
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Affiliation(s)
- Angelique S Do
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Monis A Khan
- Department of Neurologic and Orthopedic Surgery, University of Arizona, Phoenix, USA
| | - Lindsey Ross
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Robert Ravinsky
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, USA
| | - Adam J Milam
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Seung J Lee
- Department of Neurosurgery, Mayo Clinic, Jacksonville, USA
| | - Omar Durra
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - J Patrick Johnson
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA
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Milam AJ, Vandenberg M, Kraus M. In Response. Anesth Analg 2024; 138:e11-e12. [PMID: 38215723 DOI: 10.1213/ane.0000000000006798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Affiliation(s)
- Adam J Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona,
| | - Megan Vandenberg
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Molly Kraus
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
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Milam AJ, Ogunniyi MO, Faloye AO, Castellanos LR, Verdiner RE, Stewart JW, Chukumerije M, Okoh AK, Bradley S, Roswell RO, Douglass PL, Oyetunji SO, Iribarne A, Furr-Holden D, Ramakrishna H, Hayes SN. Racial and Ethnic Disparities in Perioperative Health Care Among Patients Undergoing Cardiac Surgery: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 83:530-545. [PMID: 38267114 DOI: 10.1016/j.jacc.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/08/2023] [Indexed: 01/26/2024]
Abstract
There has been little progress in reducing health care disparities since the 2003 landmark Institute of Medicine's report Unequal Treatment. Despite the higher burden of cardiovascular disease in underrepresented racial and ethnic groups, they have less access to cardiologists and cardiothoracic surgeons, and have higher rates of morbidity and mortality with cardiac surgical interventions. This review summarizes existing literature and highlights disparities in cardiovascular perioperative health care. We propose actionable solutions utilizing multidisciplinary perspectives from cardiology, cardiac surgery, cardiothoracic anesthesiology, critical care, medical ethics, and health disparity experts. Applying a health equity lens to multipronged interventions is necessary to eliminate the disparities in perioperative health care among patients undergoing cardiac surgery.
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Affiliation(s)
- Adam J Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona, USA.
| | - Modele O Ogunniyi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Grady Health System, Atlanta, Georgia, USA
| | - Abimbola O Faloye
- Department of Anesthesiology, Emory University, Atlanta, Georgia, USA. https://twitter.com/bfaloyeMD
| | - Luis R Castellanos
- Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego, La Jolla, California, USA. https://twitter.com/lrcastel
| | - Ricardo E Verdiner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona, USA. https://twitter.com/VerdinerMD
| | - James W Stewart
- Yale School of Medicine, Department of Surgery, New Haven, Connecticut, USA. https://twitter.com/stewartwjames
| | - Merije Chukumerije
- Department of Cardiovascular Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA. https://twitter.com/DrMerije
| | - Alexis K Okoh
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. https://twitter.com/OkohMD
| | - Steven Bradley
- Department of Anesthesia and Critical Care, Moffitt Cancer Center, Tampa, Florida, USA. https://twitter.com/stevenbradleyMD
| | - Robert O Roswell
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell Health, New York, New York, USA. https://twitter.com/DrRobRoswell
| | - Paul L Douglass
- Center for Cardiovascular Care, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Shakirat O Oyetunji
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington, USA. https://twitter.com/LaraOyetunji
| | - Alexander Iribarne
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | - Debra Furr-Holden
- Department of Epidemiology, School of Global Public Health, New York University, New York, New York, USA. https://twitter.com/DrDebFurrHolden
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/SharonneHayes
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Burton BN, Adeola JO, Do VM, Milam AJ, Cannesson M, Norris KC, Lopez NE, Gabriel RA. Differences in the Receipt of Regional Anesthesia Based on Race and Ethnicity in Colorectal Surgery. Jt Comm J Qual Patient Saf 2024:S1553-7250(24)00004-7. [PMID: 38433070 DOI: 10.1016/j.jcjq.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Health equity in pain management during the perioperative period continues to be a topic of interest. The authors evaluated the association of race and ethnicity with regional anesthesia in patients who underwent colorectal surgery and characterized trends in regional anesthesia. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2020, the research team identified patients who underwent open or laparoscopic colorectal surgery. Associations between race and ethnicity and use of regional anesthesia were estimated using logistic regression models. RESULTS The final sample size was 292,797, of which 15.6% (n = 45,784) received regional anesthesia. The unadjusted rates of regional anesthesia for race and ethnicity were 15.7% white, 15.1% Black, 12.8% Asian, 29.6% American Indian or Alaska Native, 16.3% Native Hawaiian or Pacific Islander, and 12.4% Hispanic. Black (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.90-0.96, p < 0.001) and Asian (OR 0.76, 95% CI 0.71-0.80, p < 0.001) patients had lower odds of regional anesthesia compared to white patients. Hispanic patients had lower odds of regional anesthesia compared to non-Hispanic patients (OR 0.72, 95% CI 0.68-0.75, p < 0.001). There was a significant annual increase in regional anesthesia from 2015 to 2020 for all racial and ethnic cohorts (p < 0.05). CONCLUSION There was an annual increase in the use of regional anesthesia, yet Black and Asian patients (compared to whites) and Hispanics (compared to non-Hispanics) were less likely to receive regional anesthesia for colorectal surgery. These differences suggest that there are racial and ethnic differences in regional anesthesia use for colorectal surgery.
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Nesoff ED, Aronowitz SV, Milam AJ, Furr-Holden CDM. Development of a systematic social observation tool for monitoring use of harm reduction supplies. Int J Drug Policy 2023; 122:104235. [PMID: 37890392 PMCID: PMC10842406 DOI: 10.1016/j.drugpo.2023.104235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Harm reduction services such as safer injection supply distribution are essential to reducing morbidity and mortality among people who use drugs (PWUD); however, local use of harm reduction supplies (e.g., tourniquets, saline solution) is difficult to routinely and systematically monitor. The purpose of this study was to develop and validate a systematic social observation tool designed to assess use of harm reduction supplies at the street block level. METHODS Data collection took place on a random sample of 150 blocks located throughout the Kensington neighborhood of North Philadelphia from November 2021 to January 2022. We measured inter-rater reliability by two-way mixed-effects intra-class correlation coefficients (ICC) with the consistency agreement definition and internal consistency reliability using Cronbach's alpha and McDonald's omega. Exploratory factor analysis with principal component extraction and promax rotation assessed internal consistency. We validated scales against locations of public syringe disposal boxes, a proxy measure for areas of concentrated drug use, using logistic regression. RESULTS Naloxone canisters, syringe caps, saline and sterile water solution bottles showed the highest reliability (ICC≥0.7). Items also showed high internal consistency (alpha, omega>0.7). Exploratory factor analysis identified one, three-item scale with high internal consistency: syringe caps, vials, and baggies (alpha = 0.85; omega = 0.85)-all supplies used concurrently with drug injection but not discarded in syringe disposal boxes. Drug use (OR = 1.78, 95 % CI = (1.48, 2.23)), harm reduction (OR = 3.53, 95 % CI = (2.20, 6.12)), and EFA scales (OR = 1.85, 95 %CI = (1.51, 2.34)) were significantly and positively associated with being within walking distance (≤0.25 miles or 0.4 km) of a syringe disposal box. CONCLUSION This study provides an efficient tool with high reliability and validity metrics to assess community uptake of harm reduction supplies designed for use by community organizations, policy makers, or other groups providing resources to PWUD.
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Affiliation(s)
- Elizabeth D Nesoff
- University of Pennsylvania Perelman School of Medicine; Department of Biostatistics, Epidemiology, and Informatics; 423 Guardian Dr, Philadelphia, PA 19104, USA.
| | - Shoshana V Aronowitz
- University of Pennsylvania School of Nursing; Department of Family and Community Health; 418 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Adam J Milam
- Mayo Clinic; Department of Anesthesiology and Perioperative Medicine; 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA
| | - C Debra M Furr-Holden
- NYU School of Global Public Health; Department of Epidemiology; 708 Broadway, New York, NY 10003, USA
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Patel S, Alfafara C, Kraus MB, Buckner-Petty S, Bonner T, Youssef MR, Poterack KA, Mour G, Mathur AK, Milam AJ. Individual- and Community-Level Socioeconomic Status and Deceased Donor Renal Transplant Outcomes. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01851-8. [PMID: 37962790 DOI: 10.1007/s40615-023-01851-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND This study examined the relationship between socioeconomic status (SES), race, and ethnicity and clinical outcomes following deceased donor kidney transplant (DDKT) at a high-volume transplant center. METHODS This retrospective cohort study used regression models and survival analyses to examine the relationship between individual- and community-level SES, race, and ethnicity and DDKT outcomes (i.e., delayed graft function, graft failure, mortality) adjusting for potential confounders. RESULTS The analytic sample included 3366 patients; 40.7% (n = 1370) were female, the mean age was 54.7 (SD = 13.3) years, 49.3% were non-Hispanic White, and the median follow-up time was 39.5 months (IQR = 24.2-68.1). Patients living in the most disadvantaged communities (using the US Census data) had a higher likelihood of delayed graft function (adjusted relative risk [RR] = 1.12, p = 0.042) and a higher hazard of mortality (adjusted hazard ratio [HR] = 1.32, p = 0.025) compared to patients living in the least disadvantaged communities. Patients without a high school diploma had a higher risk of delayed graft function compared to patients with an associate degree or more (RR = 1.37, p < 0.001). Patients with public insurance coverage had a higher risk of delayed graft function (RR = 1.24, p < 0.001) and a higher hazard of mortality (HR = 1.37, p < 0.001) and graft failure (HR = 1.71, p < 0.001) compared to patients without public insurance. There were no differences in graft failure or mortality by race and ethnicity. CONCLUSIONS SES was not consistently associated with outcomes following DDKT; however, many of the predictors were associated with delayed graft function. With a large and diverse sample size, these findings further the heterogeneity of the present renal transplant research suggesting the need for further investigation to guide implementation of innovative strategies and interventions.
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Affiliation(s)
- Shyam Patel
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, 85259, USA
| | - Chelsea Alfafara
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Molly B Kraus
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Skye Buckner-Petty
- Department of Clinical Trials and Biostatistics, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Timethia Bonner
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Mohanad R Youssef
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Karl A Poterack
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Girish Mour
- Division of Nephrology, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Amit K Mathur
- Division of Transplant Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Adam J Milam
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
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Vandenberg MT, Kraus M, Misra L, Hertzberg L, Buckner-Petty S, Padmanabhan A, Tollinche LE, Milam AJ. Racial Disparities in Compensation Among US Anesthesiologists: Results of a National Survey of Anesthesiologists. Anesth Analg 2023; 137:268-276. [PMID: 37097908 DOI: 10.1213/ane.0000000000006484] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
BACKGROUND A racial compensation disparity among physicians across numerous specialties is well documented and persists after adjustment for age, sex, experience, work hours, productivity, academic rank, and practice structure. This study examined national survey data to determine whether there are racial differences in compensation among anesthesiologists in the United States. METHODS In 2018, 28,812 active members of the American Society of Anesthesiologists were surveyed to examine compensation among members. Compensation was defined as the amount reported as direct compensation on a W-2, 1099, or K-1, plus all voluntary salary reductions (eg, 401[k], health insurance). Covariates potentially associated with compensation were identified (eg, sex and academic rank) and included in regression models. Racial differences in outcome and model variables were assessed via Wilcoxon rank sum tests and Pearson's χ 2 tests. Covariate adjusted ordinal logistic regression estimated an odds ratio (OR) for the relationship between race and ethnicity and compensation while adjusting for provider and practice characteristics. RESULTS The final analytical sample consisted of 1952 anesthesiologists (78% non-Hispanic White). The analytic sample represented a higher percentage of White, female, and younger physicians compared to the demographic makeup of anesthesiologists in the United States. When comparing non-Hispanic White anesthesiologists with anesthesiologists from other racial and ethnic minority groups, (ie, American Indian/Alaska Native, Asian, Black, Hispanic, and Native Hawaiian/Pacific Islander), the dependent variable (compensation range) and 6 of the covariates (sex, age, spousal work status, region, practice type, and completed fellowship) had significant differences. In the adjusted model, anesthesiologists from racial and ethnic minority populations had 26% lower odds of being in a higher compensation range compared to White anesthesiologists (OR, 0.74; 95% confidence interval [CI], 0.61-0.91). CONCLUSIONS Compensation for anesthesiologists showed a significant pay disparity associated with race and ethnicity even after adjusting for provider and practice characteristics. Our study raises concerns that processes, policies, or biases (either implicit or explicit) persist and may impact compensation for anesthesiologists from racial and ethnic minority populations. This disparity in compensation requires actionable solutions and calls for future studies that investigate contributing factors and to validate our findings given the low response rate.
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Affiliation(s)
| | - Molly Kraus
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Lopa Misra
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Linda Hertzberg
- Department of Anesthesiology, St Agnes Medical Center, Fresno, California
| | - Skye Buckner-Petty
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Asha Padmanabhan
- Department of Anesthesiology, Bethesda West Hospital, Boynton Beach, Florida
| | - Luis E Tollinche
- Department of Anesthesiology, MetroHealth Medical Center of Case Western Reserve University, Cleveland, Ohio
| | - Adam J Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
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Abd-Elsayed A, Rupp A, D 'Souza RS, Hussain N, Milam AJ, Strand N, Viswanath O, Falowski S, Sayed D, Deer T. Interventional Pain Physician Burnout During the COVID-19 Pandemic: A Survey from the American Society of Pain and Neuroscience. Curr Pain Headache Rep 2023:10.1007/s11916-023-01121-6. [PMID: 37395899 DOI: 10.1007/s11916-023-01121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE OF REVIEW The study sought to assess the prevalence of physician burnout among interventional pain physicians in 2022. RECENT FINDINGS Physician burnout is major psychosocial and occupational health issue. Prior to the coronavirus disease of 2019 (COVID-19) pandemic, over 60% of physicians reported emotional exhaustion and burnout. Physician burnout was reported to become more prevalent in multiple medical specialties during the COVID-19 pandemic. An 18-question survey was distributed electronically to all ASPN members (n = 7809) in the summer of 2022 to assess demographics, burnout characteristics (e.g., Have you felt burned out due to COVID?), and strategies to cope with burnout and stress (e.g., reached out for mental health assistance). Members were able to complete the survey once and were unable to make changes to their responses once submitted. Descriptive statistics were used to assess the prevalence and severity of physician burnout within the ASPN community. Chi-square tests were used to examine differences in burnout by provider characteristics (age, gender, years practicing, and practice type) with p-values less than 0.05 indicating statistical significance. There were 7809 ASPN members that received the survey email, 164 of those members completed the survey, a response rate of 2.1%. The majority of respondents were male (74.1%, n = 120), 94% were attending physicians (n = 152), and 26% (n = 43) have been in practice for twenty years or longer. Most respondents expressed having experienced burnout during the COVID pandemic (73.5%, n = 119), 21.6% of the sample reported reduced hours and responsibilities during the pandemic, and 6.2% of surveyed physicians quit or retired due to burnout. Nearly half of responders reported negative impacts to their family and social lives as well as personal physical and mental health. A variety of negative (e.g., changes in diet, smoking/vaping) and positive coping strategies (e.g., exercise and training, spiritual enrichment) were employed in response to stress and burnout; 33.5% felt they should or had reached out for mental health assistance and suicidal ideations were expressed in 6.2% due to burnout. A high percentage of interventional pain physicians continue to experience mental symptoms that may lead to risk for significant issues going forward. Our findings should be interpreted with caution based on the low response rate. Evaluation of burnout should be incorporated into annual assessments given issues of survey fatigue and low survey response rates. Interventions and strategies to address burnout are warranted.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, School of Medicine & Public Health, University of Wisconsin, Madison, WI, USA.
| | - Adam Rupp
- Department of Rehabilitation Medicine, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Ryan S D 'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Colombus, OH, USA
| | - Adam J Milam
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Natalie Strand
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Omar Viswanath
- Department of Anesthesiology, Creighton University School of Medicine, Phoenix, AZ, USA
| | - Steven Falowski
- Neurosurgical Associates of Lancaster, Lancaster, PA, 17601, USA
| | - Dawood Sayed
- Department of Anesthesiology, Division of Pain Medicine, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Timothy Deer
- The Spine & Nerve Centers of the Virginias, Charleston, WV, USA
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Dunn TM, Patel S, Milam AJ, Brinkman J, Gorlin A, Harbell M. The Influence of Social Media on Applicant Perceptions of Anesthesiology Residency Programs during the COVID-19 Pandemic. JMIR Med Educ 2023. [PMID: 37205642 DOI: 10.2196/39831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Social media may be an effective tool in residency recruitment given its ability to engage a broad audience, however, there is limited data regarding the influence of social media on applicants' evaluation of anesthesiology residency programs. OBJECTIVE This study evaluates the influence of social media on applicants' perceptions of anesthesiology residency programs during the COVID-19 pandemic to allow programs to evaluate the importance of a social media presence for residency recruitment. The study also sought to understand if there were differences in the utility of social media by applicant demographic characteristics (e.g., race, ethnicity, gender, age). We hypothesized that given the COVID-19 pandemic restrictions on visiting rotations and the interview process, the social media presence of anesthesiology residency programs would have a positive impact on the recruitment process and be an effective form of communication about program characteristics. METHODS All anesthesiology residency applicants who applied to Mayo Clinic Arizona were emailed a survey in October 2020 along with statements regarding the anonymity and optional nature of the survey. The 20-item Qualtrics survey included questions regarding sub-internship rotation completion, social media resource use and impact (e.g., Residency-based social media accounts positively impacted my opinion of the program), and applicant demographic characteristics. Descriptive statistics were examined, and perceptions of social media were stratified by gender, race, and ethnicity; a factor analysis was performed, and the resulting scale was regressed on race, ethnicity, age, and gender. RESULTS The survey was emailed to 1,091 individuals who applied to the Mayo Clinic Arizona anesthesiology residency program; there were 640 unique responses recorded (response rate = 58.6%). Nearly 65% of applicants reported an inability to complete 2 or more planned sub-internships due to COVID-19 restrictions (n = 361, 55.9%), with 25% of applicants reporting inability to do any visiting student rotations (n = 167). Official program websites (91.5%), Doximity (47.6%), Instagram (38.5%), and Twitter (19.4%) were reported as the most used resource by applicants. The majority of applicants (n = 385; 67.3%) agreed that social media was an effective means to inform applicants and 57.5% (n = 328) indicated that social media positively impacted their perception of the program. An 8-item scale with good reliability was created, representing the importance of social media (Cronbach's α = 0.838). There was a positive and statistically significant relationship such that male applicants (Standardized β = 0.151, p = 0.002) and older applicants (β = 0.159, p < 0.001) had less trust and reliance in social media for information regarding anesthesiology residency programs. The applicant's race and ethnicity was not associated with the social media scale (β = -0.089, p = 0.079). CONCLUSIONS Social media was an effective means to inform applicants, and generally positively impacted applicants' perception of programs. Thus, residency programs should consider investing time and resources towards building a social media presence to improve resident recruitment. CLINICALTRIAL
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Affiliation(s)
- Tyler Michael Dunn
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E. Mayo Blvd., Phoenix, US
| | - Shyam Patel
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Phoenix, US
| | - Adam J Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, US
| | | | - Andrew Gorlin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, US
| | - Monica Harbell
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, US
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Milam AJ, Ramakrishna H. Predicting Survival After HeartMate 3 Left Ventricular Assist Device Implantation-Progress Continues. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00250-1. [PMID: 37149472 DOI: 10.1053/j.jvca.2023.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Adam J Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
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Yu S, Tavarez-Mora F, Milam AJ, Misra L, Aljure O, Glas K, Shillcutt S. Matters of the Heart: Examining Motivating Factors and Unconscious Bias in Adult Cardiothoracic Anesthesiology Fellowship. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00136-2. [PMID: 37030989 DOI: 10.1053/j.jvca.2023.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/19/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVES The purpose of this study was to identify barriers to improving diversity within adult cardiothoracic anesthesiology (ACTA) and to provide possible strategies that could be implemented by evaluating the demographics of current ACTA fellows, examining motivating factors to pursue the sub-specialty, and assessing perceptions of unconscious biases during their application process and training. DESIGN A survey was created by the authors and distributed electronically by the Society of Cardiovascular Anesthesiologists to the ACTA Fellows from April to June 2022. SETTING A multicenter survey. PARTICIPANTS Recent 2021 to 2022 ACTA fellows. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 68 fellows were included in the analytical sample; 37.3% were women, and 58.2% were men. Half of the participants in the sample were White race (47%), 26% were Asian, 8% Hispanic or Latinx, 5% Black, and 2% were Pacific Islander or Native Hawaiian. Most fellows indicated that the complexity of cases and/or competency in transesophageal echocardiography was "very important" in their motivating factor (74.0%). When examining sex differences, female fellows reported (p value <0.05) that their experience was impacted negatively by sex and was more often treated with less respect and courtesy. There were no statistically significant differences in perceived discrimination by race and/or ethnicity. CONCLUSIONS This study identified several motivators to pursue ACTA and the perceptions of unconscious biases during the fellowship. Female fellows felt unconscious bias and a negative impact against them due to sex. Due to the small number of undergraduate enrollments, the results should be interpreted cautiously. Additionally, this provides support to complete further studies. Implicit bias training is one strategy that can be implemented to decrease unconscious bias experienced by ACTA fellows.
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17
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Milam AJ, Hung P, Bradley AS, Herrera-Quiroz D, Soh I, Ramakrishna H. Open Versus Endovascular Repair of Descending Thoracic Aneurysms: Analysis of Outcomes. J Cardiothorac Vasc Anesth 2023; 37:483-492. [PMID: 36522256 DOI: 10.1053/j.jvca.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Adam J Milam
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ
| | - Penny Hung
- Medical Student, Mayo Clinic Alix School of Medicine, Scottsdale, AZ
| | - A Steven Bradley
- Department of Anesthesiology, Uniformed Services University of Health Sciences, Bethesda, MD
| | | | - Ina Soh
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - Harish Ramakrishna
- Division of Cardiovascular Anesthesia, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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18
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Milam AJ, Liang C, Mi J, Mascha EJ, Halvorson S, Yan M, Soltesz E, Duncan AE. Derivation and Validation of Clinical Phenotypes of the Cardiopulmonary Bypass-Induced Inflammatory Response. Anesth Analg 2023; 136:507-517. [PMID: 36730794 DOI: 10.1213/ane.0000000000006247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Precision medicine aims to change treatment from a "one-size-fits-all" approach to customized therapies based on the individual patient. Applying a precision medicine approach to a heterogeneous condition, such as the cardiopulmonary bypass (CPB)-induced inflammatory response, first requires identification of homogeneous subgroups that correlate with biological markers and postoperative outcomes. As a first step, we derived clinical phenotypes of the CPB-induced inflammatory response by identifying patterns in perioperative clinical variables using machine learning and simulation tools. We then evaluated whether these phenotypes were associated with biological response variables and clinical outcomes. METHODS This single-center, retrospective cohort study used Cleveland Clinic registry data from patients undergoing cardiac surgery with CPB from January 2010 to March 2020. Biomarker data from a subgroup of patients enrolled in a clinical trial were also included. Patients undergoing emergent surgery, off-pump surgery, transplantation, descending thoracoabdominal aortic surgery, and planned ventricular assist device placement were excluded. Preoperative and intraoperative variables of patient baseline characteristics (demographics, comorbidities, and laboratory data) and perioperative data (procedural data, CPB duration, and hemodynamics) were analyzed to derive clinical phenotypes using K-means-based consensus clustering analysis. Proportion of ambiguously clustered was used to assess cluster size and optimal cluster numbers. After clusters were formed, we summarized perioperative profiles, inflammatory biomarkers (eg, interleukin [IL]-6 and IL-8), kidney biomarkers (eg, urine neutrophil gelatinase-associated lipocalin [NGAL] and IL-18), and clinical outcomes (eg, mortality and hospital length of stay). Pairwise standardized difference was reported for all summarized variables. RESULTS Of 36,865 eligible cardiac surgery cases, 25,613 met inclusion criteria. Cluster analysis derived 3 clinical phenotypes: α, β, and γ. Phenotype α (n = 6157 [24%]) included older patients with more comorbidities, including heart and kidney failure. Phenotype β (n = 10,572 [41%]) patients were younger and mostly male. Phenotype γ (n = 8884 [35%]) patients were 58% female and had lower body mass index (BMI). Phenotype α patients had worse outcomes, including longer hospital length of stay (mean = 9 days for α versus 6 for both β [absolute standardized difference {ASD} = 1.15] and γ [ASD = 1.08]), more kidney failure, and higher mortality. Inflammatory biomarkers (IL-6 and IL-8) and kidney injury biomarkers (urine NGAL and IL-18) were higher with the α phenotype compared to β and γ immediately after surgery. CONCLUSIONS Deriving clinical phenotypes that correlate with response biomarkers and outcomes represents an initial step toward a precision medicine approach for the management of CPB-induced inflammatory response and lays the groundwork for future investigation, including an evaluation of the heterogeneity of treatment effect.
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Affiliation(s)
- Adam J Milam
- From the Departments of Cardiothoracic Anesthesiology
| | - Chen Liang
- Quantitative Health Sciences.,Outcomes Research
| | - Junhui Mi
- Quantitative Health Sciences.,Outcomes Research
| | | | | | - Manshu Yan
- From the Departments of Cardiothoracic Anesthesiology
| | - Edward Soltesz
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Andra E Duncan
- From the Departments of Cardiothoracic Anesthesiology.,Outcomes Research
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19
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Burton BN, Wall PV, Le D, Milam AJ, Gabriel RA. Racial Differences in 30-Day Reintubation After Head and Neck Surgery. Cureus 2023; 15:e35280. [PMID: 36968936 PMCID: PMC10038682 DOI: 10.7759/cureus.35280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Background This study aimed to examine the association of race and ethnicity with 30-day unplanned reintubation following head and neck surgery. Methodology A retrospective analysis of head and neck surgery patients aged greater than or equal to 18 years was extracted from the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2020. Patient demographics, comorbidities, and 30-day reintubation were included in the analysis. Pearson's chi-square and independent samples t-test were used to compare reintubation cohorts. Multivariable logistic regression was used to identify the association of race and ethnicity with 30-day reintubation. Results Of the total 108,442 head and neck surgery cases included, 74.9% of patients were non-Hispanic White, 17.3% were non-Hispanic Black, and 7.7% were Hispanic. The overall 30-day reintubation rate was 0.33%. After adjusting for age, body mass index, sex, and comorbidities, non-Hispanic Black patients had increased 30-day reintubation compared to non-Hispanic White patients (odds ratio [OR] = 2.14, 95% confidence interval [CI] 1.70-2.69, and P < 0.0001). There was no difference in 30-day reintubation for Hispanic patients compared to non-Hispanic White patients (OR = 1.08, 95% CI 0.67-1.65, and P = 0.747). Conclusions This analysis showed that non-Hispanic Black patients disproportionately had higher odds of 30-day reintubation following head and neck surgery. Hispanic ethnicity was not associated with increased odds of 30-day reintubation. More studies are needed to investigate the reasons for these racial differences.
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20
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Milam AJ, McDougle L, Furr-Holden D. In Reply to Yung and Morris. Acad Med 2023; 98:9. [PMID: 36576761 DOI: 10.1097/acm.0000000000005014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Adam J Milam
- Associate professor of anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona; ; ORCID: https://orcid.org/0000-0001-9306-1598
| | - Leon McDougle
- Professor of Family Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Debra Furr-Holden
- Dean, New York University School of Global Public Health, New York, New York
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21
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Patton JW, Burton BN, Milam AJ, Mariano ER, Gabriel RA. Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients. Int Anesthesiol Clin 2023; 61:8-15. [PMID: 36398629 DOI: 10.1097/aia.0000000000000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- John W Patton
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
| | - Brittany N Burton
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
| | - Adam J Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Rodney A Gabriel
- Divisions of Regional Anesthesia and Perioperative Informatics, Department of Anesthesiology, University of California San Diego, San Diego, California
- Department of Biomedical Informatics, University of California San Diego, San Diego, California
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22
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Milam AJ, Oboh O, Brown Z, Edwards-Johnson J, Terry A, Barajas CB, Simon KM, Furr-Holden CDM. Symptoms of Depression and Anxiety Among Black Medical Students: the Role of Peer Connectedness and Perceived Discrimination. J Racial Ethn Health Disparities 2022; 9:2180-2187. [PMID: 34599490 PMCID: PMC8486160 DOI: 10.1007/s40615-021-01157-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/31/2021] [Accepted: 09/20/2021] [Indexed: 12/29/2022]
Abstract
This study examined the association between discrimination, peer connectedness, and mental health symptoms among Black medical students. Data were collected from a convenience sample of Black medical students via an anonymous electronic questionnaire (n = 733) in year 2020. The Patient-Reported Outcomes Measurement Information System Depression and Anxiety forms were used to measure depression and anxiety symptoms. Structural equation modeling was used to examine the association between discrimination, peer connectedness, and mental health symptoms (Mplus 7.3). The majority of the participants were female (80%), approximately 40% were third or fourth year medical school students, and 13% had a clinical diagnosis of depression/anxiety before medical school. About half of the students reported being watched more closely than their classmates, and 66% reported feeling the need to work twice as hard as others to get the same treatment or evaluation. The majority of students reported that their peers were supportive of their academic success (60.7%), and 53% reported that students often or always invited them to social outings. The mean T-score for depressive symptoms was 53.6 (SD = 7.8), and the mean T-score for anxiety symptoms was 58.6 (SD = 8.4). Overall, findings indicated a high prevalence of anxiety and depression symptoms among Black medical students, and increased discrimination was associated with more mental health symptoms among males. Additionally, increased peer connectedness was associated with fewer symptoms of anxiety among males and females and fewer depressive symptoms among females. Addressing discrimination among medical students may improve mental health among Black medical students.
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Affiliation(s)
- Adam J Milam
- Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205, USA.
- Mayo Clinic Arizona, Phoenix, USA.
| | - Osose Oboh
- College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Zackary Brown
- Howard University School of Medicine, Washington, DC, USA
| | | | | | - Clara B Barajas
- College of Human Medicine Division of Public Health, Michigan State University, Flint, MI, USA
| | - Kevin M Simon
- Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - C Debra M Furr-Holden
- Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205, USA
- Department of Family Medicine, Michigan State University, Flint, MI, USA
- College of Human Medicine Division of Public Health, Michigan State University, Flint, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, Flint, MI, USA
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23
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Gepty AA, Lambert SF, Milam AJ, Ialongo NS. Residential mobility, neighborhood cohesion, and depressive symptoms among urban-dwelling African American adolescents. J Community Psychol 2022; 50:3280-3299. [PMID: 35332553 PMCID: PMC9378346 DOI: 10.1002/jcop.22837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/30/2021] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
Mechanisms linking residential mobility and depressive symptoms among urban-dwelling African American adolescents have received little attention. This study examined neighborhood cohesion as a possible mechanism. Participants were 358 urban-dwelling African American adolescents (Mage = 14.78; SD = 0.34) who reported their neighborhood cohesion in Grade 10 and depressive symptoms in Grades 9 and 11, and for whom residential address information was available. There was a significant indirect effect of past moves in middle school on depressive symptoms 1 year later through reduced neighborhood cohesion. However, the indirect effect was not significant in a propensity score-matched sample. Results from the full sample of adolescents suggest that neighborhood cohesion may play a role in the experience of depressive symptoms following past moves in middle school. Different findings for the propensity score-matched sample highlight the need for future studies of residential mobility to employ strategies to correct for possible selection bias.
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Affiliation(s)
- Andrew A. Gepty
- Department of Psychological and Brain Sciences, The George Washington University
| | - Sharon F. Lambert
- Department of Psychological and Brain Sciences, The George Washington University
| | - Adam J. Milam
- Bloomberg School of Public Health, Johns Hopkins University
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Debnam KJ, Milam AJ, Finigan-Carr N. Superwoman, Racial Identity, and Teen Dating Violence Victimization among Young Black Women. J Interpers Violence 2022; 37:NP15970-NP15991. [PMID: 34092132 DOI: 10.1177/08862605211021984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Young Black women consistently report the highest rates of teen dating violence (TDV) in the United States. They are also navigating a world in which they are facing historical marginalization and intersectional oppression. The Superwoman stereotypic role, in which Black women showcase strength and resist vulnerability, is often adapted in reaction to this normalized existence. Yet little research has examined how these constructs are related. In addition, research suggests that a positive racial identity may function as a psychological buffer against society's negative view of Black Americans and reduce involvement in violence. The current study examined the relationship between endorsement of a Superwoman role and TDV victimization among young Black women. A total of 481 Black women, aged 18-19, completed online survey measures assessing their racial identity beliefs, endorsement of racial stereotypes, and TDV experiences. The results of the path models showed that endorsement of a Superwoman role was associated with increased TDV victimization. Results also showed that racial centrality was inversely associated with TDV; the more the young women felt that being Black was a central part of their identity, the less they reported victimization. Findings suggest a need for attention to stereotype development and racial identity in the development of healthy romantic relationships for Black youth.
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Affiliation(s)
| | - Adam J Milam
- Johns Hopkins University, Bloomberg School of Public Health
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Milam AJ, Brown I, Edwards-Johnson J, McDougle L, Sousa A, Furr-Holden D. Experiences of Discrimination, Institutional Responses to Seminal Race Events, and Depressive Symptoms in Black U.S. Medical Students. Acad Med 2022; 97:876-883. [PMID: 35703911 PMCID: PMC9204755 DOI: 10.1097/acm.0000000000004638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students. METHOD This study collected data from a convenience sample of Black U.S. medical students via an anonymous electronic questionnaire in August 2020 that was distributed through the Student National Medical Association and Organization of Student Representatives listservs and an author's social media accounts. It included questions on demographics, institutional responses to seminal race events, experiences of discrimination, and symptoms of depression. Path models were used to examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students. RESULTS Of the 750 students completing the survey, 733 (97.7%) were Black. Experiences of discrimination and a lack of institutional responses to seminal race events were associated with more depressive symptoms (b = 0.19, 95% CI: 0.11, 0.26; P < .001 and b = 0.12, 95% CI: 0.04, 0.20; P = .01). After controlling for gender and clinical diagnosis of depression or anxiety before medical school, there was a relationship between experiences of discrimination and institutional responses to seminal race events such that students who reported more experiences of discrimination were more likely to report that their institution did not respond to seminal race events (b = 0.41, 95% CI: 0.34, 0.48; P < .001). Experiences of discrimination moderated the relationship between institutional responses to seminal race events and depressive symptoms (i.e., the relationship between a lack of institutional responses to seminal race events and depressive symptoms was stronger among students who reported more frequent experiences of discrimination). CONCLUSIONS Institutions dedicated to supporting Black medical student wellness must be diligent in cultivating a culture intolerant of discrimination and deft in their responses to seminal race events in the larger culture.
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Affiliation(s)
- Adam J Milam
- A.J. Milam is associate professor of anesthesiology, Mayo Clinic, Phoenix, Arizona; ORCID: https://orcid.org/0000-0001-9306-1598
| | - Italo Brown
- I. Brown is assistant professor of emergency medicine, Stanford University School of Medicine, Stanford, California
| | - Jennifer Edwards-Johnson
- J. Edwards-Johnson is associate professor and community assistant dean, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Leon McDougle
- L. McDougle is professor of family medicine and associate dean for diversity and inclusion, The Ohio State University College of Medicine, Columbus, Ohio; ORCID: https://orcid.org/0000-0003-2400-8763
| | - Aron Sousa
- A. Sousa is interim dean, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Debra Furr-Holden
- D. Furr-Holden is the C.S. Mott Endowed Professor of Public Health and associate dean for public health integration, College of Human Medicine, Michigan State University, East Lansing, Michigan; ORCID: https://orcid.org/0000-0002-9337-9886
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Patel S, Lin KK, Milam AJ, Yu S, Raynor G, Narjeet K, Verdiner R, Girardo ME, Misra L. Diversity, Equity, and Inclusion Among Anesthesiology Trainees. Women's Health Reports 2022; 3:414-419. [PMID: 35559355 PMCID: PMC9081057 DOI: 10.1089/whr.2021.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/17/2022]
Abstract
Background: Historically in medicine, women and minorities have been underrepresented. This trend is especially significant in the anesthesiology workforce. Objective: The goals of this study were to quantify the current state of diversity by race/ethnicity, gender, and sexual orientation among anesthesiology residents. Methods: An institutionally reviewed and validated survey was delivered through Qualtrics to 130 anesthesiology program directors. Topics addressed included gender identity, sexual orientation, racial and ethnic background, rationale for pursuing anesthesiology, and medical training experiences. The study was administered from February to April 2021; 135 anesthesiology residents responded to the survey. Results: The sample was 44.4% white (n = 60), 54.1% male (n = 73), and 83.7% (n = 113) of respondents self-reported as straight or heterosexual. Respondents indicated that role models/mentors were somewhat or very important in their desire to pursue anesthesiology (n = 85; 67.2%), 42% reported that having women/diverse faculty was somewhat or very important in their decision to pursue anesthesiology. Discrimination during the anesthesiology residency application process or as a resident ranged from 4.4% due to sexual orientation to 18.7% due to gender/gender identity and race/ethnicity. Conclusions: Experiences of discrimination based on race/ethnicity, gender, and gender identity continues to be a concern among anesthesiology trainees. Creating an environment that is inclusive and supportive of all trainees regardless of race/ethnicity, gender/gender identity, and sexual orientation is needed. Interventions and strategies to create an inclusive environment may improve diversity within anesthesiology.
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Affiliation(s)
- Shyam Patel
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | - Keldon K. Lin
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | - Adam J. Milam
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Soojie Yu
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Gwendolyn Raynor
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Khurmi Narjeet
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Ricardo Verdiner
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Marlene E. Girardo
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Lopa Misra
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Milam AJ, Furr-Holden D, Wang L, Simon KM. Health Data Disparities in Opioid-Involved Overdose Deaths From 1999 to 2018 in the United States. Am J Public Health 2021; 111:1627-1635. [PMID: 34185576 PMCID: PMC8589046 DOI: 10.2105/ajph.2021.306322] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 01/09/2023]
Abstract
Objectives. To examine temporal trends in the classification of opioid-involved overdose deaths (OODs) and racial variation in the classification of specific types of opioids used. Methods. We analyzed OODs coded as other or unspecified narcotics from 1999 to 2018 in the United States using data from the National Vital Statistics System and the Centers for Disease Control and Prevention. Results. The total proportion of OODs from unspecified narcotics decreased from 32.4% in 1999 to 1.9% in 2018. The proportion of OODs from unspecified narcotics among African American persons was approximately 2-fold greater than that of non-Hispanic White persons until 2012. Similarly, the proportion of OODs from unspecified narcotics among Hispanic persons was greater than that of White persons until 2015. After we controlled for death investigation system, African American persons had a higher incidence rate of OODs from unspecified narcotics compared with White persons. Conclusions. There have been significant improvements in the specification OODs over the past 20 years, and there has been significant racial disparity in the classification of OODs until about 2015. The findings suggest a health data disparity; the excessive misclassification of OODs is likely attributable to the race/ethnicity of the decedent.
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Affiliation(s)
- Adam J Milam
- Adam J. Milam is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH. Debra Furr-Holden is with the Division of Public Health, College of Human Medicine, Michigan State University, Flint, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health. Ling Wang is with Department of Medicine, College of Human Medicine, Michigan State University, East Lansing. Kevin M. Simon is with Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, and Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Debra Furr-Holden
- Adam J. Milam is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH. Debra Furr-Holden is with the Division of Public Health, College of Human Medicine, Michigan State University, Flint, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health. Ling Wang is with Department of Medicine, College of Human Medicine, Michigan State University, East Lansing. Kevin M. Simon is with Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, and Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Ling Wang
- Adam J. Milam is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH. Debra Furr-Holden is with the Division of Public Health, College of Human Medicine, Michigan State University, Flint, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health. Ling Wang is with Department of Medicine, College of Human Medicine, Michigan State University, East Lansing. Kevin M. Simon is with Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, and Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Kevin M Simon
- Adam J. Milam is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH. Debra Furr-Holden is with the Division of Public Health, College of Human Medicine, Michigan State University, Flint, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health. Ling Wang is with Department of Medicine, College of Human Medicine, Michigan State University, East Lansing. Kevin M. Simon is with Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, and Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA
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Debnam KJ, Milam AJ, Bottiani JH, Bradshaw CP. Teacher-Student Incongruence in Perceptions of School Equity: Associations with Student Connectedness in Middle and High Schools. J Sch Health 2021; 91:706-713. [PMID: 34287895 DOI: 10.1111/josh.13062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND School equity refers to the extent to which students are treated fairly, ensuring that each student receives what they need to be successful. School staff can play a vital role in creating an equitable school climate for adolescents, but little is known about how staff perceive equity in their school and how this in turn may relate to students' perceptions. This study sought to explore congruence between teacher and student perceptions of school equity and how congruence or incongruence related to students' sense of connectedness to school. METHODS Data for the study came from the Maryland Safe and Supportive Schools Climate Survey, which was administered online to 5523 school staff and 59,218 students across 104 middle and high schools. RESULTS Multilevel models indicated that, compared to high staff and high student ratings, there was lower connectedness among the schools with low staff, low student ratings of equity as well as the schools with high staff, low student and low staff, high student ratings of equity. CONCLUSIONS The findings suggest that staff perceptions of school equity are often higher than students and incongruence in perceptions may have a negative impact on students' connection to school.
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Affiliation(s)
- Katrina J Debnam
- Assistant Professor, , School of Nursing, School of Education & Human Development, University of Virginia, McLeod Hall Rm5007, P.O. Box 800782, Charlottesville, VA 22908-0782., USA
| | - Adam J Milam
- Faculty Associate, , Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21202., USA
| | - Jessika H Bottiani
- Research Assistant Professor, , University of Virginia, School of Education & Human Development, Ridley Hall 228, PO Box 400281, Charlottesville, VA 22904., USA
| | - Catherine P Bradshaw
- Professor, , University of Virginia, School of Education & Human Development, 417 Emmet Street South, PO Box 400260, Charlottesville, VA 22904-4260., USA
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Affiliation(s)
- Mieka Smart
- Michigan State University, College of Human Medicine, Division of Public Health, Flint, Michigan
| | - Hilbert Mendoza
- Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Aloysius Mutebi
- Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Adam J. Milam
- Michigan State University, College of Human Medicine, Division of Public Health, Flint, Michigan
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Smart M, Mendoza H, Mutebi A, Milam AJ, Tumwesigye NM. Impact of the Sachet Alcohol Ban on Alcohol Availability in Uganda. J Stud Alcohol Drugs 2021; 82:511-515. [PMID: 34343083 PMCID: PMC9798379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Alcohol use continues to be a major public health problem in Uganda. This study sought to estimate the availability of sachet alcohol among retail food and beverage establishments in two Ugandan districts (Kampala and Jinja) before and after enactment of the national sachet alcohol ban. METHOD Independent observations in 100 establishments were conducted by a pair of trained observers during the peak hours of 7 P.M. to 1 A.M. Using a standardized checklist, observers recorded indications of alcohol availability before and after enactment of the sachet alcohol ban. RESULTS Availability of (a) alcohol and (b) sachet alcohol were significantly affected by the ban. Before the ban, 69% of all establishments sold alcohol; there was a significant reduction in alcohol availability after enactment of the ban to 43% of the establishments (p < .001). This reduction was observed in off-premise establishments (p < .001), but not in on-premise establishments (p = .710). Additionally, before the sachet alcohol ban, 52% of all establishments sold sachet alcohol; however, there was a significant reduction in sachet availability after enactment of the ban (1.4%, p < .001). CONCLUSIONS Legislation banning the manufacture and sale of sachet alcohol has the potential to reduce sachet availability. Future studies should examine changes in alcohol consumption following the sachet alcohol ban.
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Affiliation(s)
- Mieka Smart
- Michigan State University, College of Human Medicine, Division of Public Health, Flint, Michigan,Correspondence may be sent to Mieka Smart at the Michigan State University College of Human Medicine, Division of Public Health, 200 E. 1st Street, Room 161, Flint, MI 48502, or via email at: . Mieka Smart conceived the study. Hilbert Mendoza and Aloysius Mutebi supervised the data collection. Mieka Smart and Hilbert Mendoza analyzed the data. All authors contributed to writing the first draft of the manuscript, critically reviewed it, and approved the final version
| | - Hilbert Mendoza
- Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Aloysius Mutebi
- Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Adam J. Milam
- Michigan State University, College of Human Medicine, Division of Public Health, Flint, Michigan
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Milam AJ. Protecting Our Most Vulnerable Populations During the COVID-19 Pandemic. Acad Med 2021; 96:786-787. [PMID: 33538467 PMCID: PMC8140630 DOI: 10.1097/acm.0000000000003954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Adam J Milam
- Chief resident, Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, and faculty associate, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ; Twitter: @ajmilammdphd; ORCID: https://orcid.org/0000-0001-9306-1598
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Nesoff ED, Milam AJ, Morrison C, Weir BW, Branas CC, Furr-Holden DM, Knowlton AR, Martins SS. Alcohol outlets, drug paraphernalia sales, and neighborhood drug overdose. Int J Drug Policy 2021; 95:103289. [PMID: 33984684 DOI: 10.1016/j.drugpo.2021.103289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 04/13/2021] [Accepted: 04/24/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Alcohol outlets have been associated with various forms of injury and may contribute to neighborhood disparities in drug overdose. Few studies have examined the associations between alcohol outlets and drug overdose. This study investigated whether alcohol outlets were associated with the neighborhood drug overdose rate and whether the sale of drug paraphernalia contributes to this association. METHODS A cross-sectional ecological spatial analysis was conducted within census block groups in Baltimore City (n = 653). Outcomes were counts of EMS calls for any drug overdose in 2015 (n = 3,856). Exposures of interest were counts of alcohol outlets licensed for off-premise and on-premise consumption and the proportion of off-premise outlets selling drug paraphernalia (e.g., blunt wrappers, baggies, pipes). Negative binomial regression was used to assess the relationship between outlet count and overdose rate, and if paraphernalia sales altered this relationship, controlling for other neighborhood factors. Spatial autocorrelation was assessed and regression inference adjusted accordingly. RESULTS Each additional off-premise alcohol outlet was associated with a 16.6% increase in the neighborhood overdose rate (IRR=1.17, 95%CI=(1.11, 1.23)), adjusted for other neighborhood variables. On-premise alcohol outlets were not significantly associated with overdose rate when adjusting for off-premise alcohol outlets (IRR=1.01, 95% CI=(0.97, 1.06)). The proportion of off-premise outlets that sold drug paraphernalia was negatively associated with overdose rate (IRR=0.55, 95% CI=(0.41, 0.74)) and did not alter the relationship between off-premise outlets and overdose. CONCLUSION This study provides preliminary public health evidence for informing policy decisions about alcohol outlet licensing and zoning. Alcohol outlets could be potential community partners for harm reduction strategies such as health communication in identifying overdose symptoms or Good Samaritan Laws.
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Affiliation(s)
- Elizabeth D Nesoff
- University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology, and Informatics, 423 Guardian Dr, Philadelphia, PA, 19104, USA; Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W168th St, 5th floor, New York, NY, 10032, USA.
| | - Adam J Milam
- Michigan State University College of Human Medicine, Department of Epidemiology and Biostatics, 200 East First Street, Flint, MI, 48502, USA
| | - Christopher Morrison
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W168th St, 5th floor, New York, NY, 10032, USA
| | - Brian W Weir
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624N. Broadway, 7th floor, Baltimore, MD, 21205, USA
| | - Charles C Branas
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W168th St, 5th floor, New York, NY, 10032, USA
| | - Debra M Furr-Holden
- Michigan State University College of Human Medicine, Department of Epidemiology and Biostatics, 200 East First Street, Flint, MI, 48502, USA
| | - Amy R Knowlton
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624N. Broadway, 7th floor, Baltimore, MD, 21205, USA
| | - Silvia S Martins
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W168th St, 5th floor, New York, NY, 10032, USA
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Abstract
Attaining equity in vaccination distribution is a moral and ethical goal that ensures all members of our community are properly cared for. We suggest a comprehensive approach that involves allocating community resources based on local economic, demographic, and COVID-19 infection data, removing technology barriers by staffing vaccine appointment call-in centers, distributing vaccines based on objective factors (eg, household density) rather than on a "first come, first served" basis, and creating pop-up vaccination sites at trusted community organizations such as federally qualified healthcare centers, churches, libraries, and barber/beauty shops. Until every community is safe, no community will be safe.
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Affiliation(s)
- Lee Kirksey
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH; Walter W. Buckley Endowed Chair, Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH
| | - Adam J Milam
- Fellow, Anesthesiology Institute, Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Caleb W Curry
- Case Western Reserve University, Undergraduate Studies, Cleveland, OH
| | - Ahmed A Sorour
- Research Fellow, Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
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Furr-Holden D, Milam AJ, Wang L, Sadler R. African Americans now outpace whites in opioid-involved overdose deaths: a comparison of temporal trends from 1999 to 2018. Addiction 2021; 116:677-683. [PMID: 32852864 DOI: 10.1111/add.15233] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/04/2020] [Accepted: 08/19/2020] [Indexed: 01/04/2023]
Abstract
AIMS To estimate racial differences in rates of opioid-involved overdose deaths (OOD) between whites and African Americans in the United States from 1999 to 2018 to (1) identify racial variation in the temporal trends of OOD during the 20-year period and (2) compare trends in OOD rates between whites and African Americans using the Centers for Disease Control and Prevention's (CDC) three defined OOD epidemic periods. METHODS Data were obtained from the CDC wide-ranging on-line data for epidemiological research, which combines OOD data from the National Vital Statistics System, and population data from the US Census Bureau. Joinpoint regression models were used to estimate age-adjusted annual percentage change (APC) in OOD by race from 1999 to 2018. RESULTS The temporal trends of OOD varied by race. African Americans had a persistently low rate of OOD and statistically non-significant rate of change in OOD from 1999 to 2012 (APC = 0.47; P > 0.05), with a statistically significant and rapid acceleration in OOD rates in 2012 that persisted to 2018 (APC = 26.16; P < 0.01). Whites had three statistically significant periods of acceleration in OOD rate from 1999 to 2006 (APC = 12.43; P < 0.01), 2006 to 2013 (APC = 4.34, P < 0.01) and the greatest increase from 2013 to 2016 (APC = 18.96; P < 0.01). Whites had a statistically non-significant decrease in OOD from 2016 to 2018 (P = 0.16). The trend for whites more closely aligned with the CDC-defined epidemic periods than for African Americans. During wave 1 (1999-2010), the average annual percentage change (AAPC) for African Americans was significantly lower than for whites (0.47 versus 9.42, P < 0.01); however, by wave 3 (2013-current; defined by the introduction of illicitly manufactured fentanyl), the AAPC was significantly higher in African Americans (26.16 versus 13.19, P < 0.01). CONCLUSIONS Despite historically lower rates of opioid misuse and opioid-involved overdose deaths among African Americans compared with whites, the growth in opioid-involved overdose deaths among African Americans now outpaces that of whites in the United States.
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Affiliation(s)
- Debra Furr-Holden
- Division of Public Health, Michigan State University College of Human Medicine, Flint, MI, USA
| | - Adam J Milam
- Division of Public Health, Michigan State University College of Human Medicine, Flint, MI, USA
| | - Ling Wang
- Department of Medicine, Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Richard Sadler
- Division of Public Health, Michigan State University College of Human Medicine, Flint, MI, USA
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Milam AJ, Furr-Holden CDM, Nesoff ED, Trangenstein PJ. Evaluation of a Local Ordinance to Prevent Any Underage Purchases in Liquor Stores: The Need for Enforcement. J Stud Alcohol Drugs 2021. [DOI: 10.15288/jsad.2021.82.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Adam J. Milam
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, Michigan
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - C. Debra M. Furr-Holden
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, Michigan
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth D. Nesoff
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Pamela J. Trangenstein
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Milam AJ, Oliver AP, Smith SA, Davis T, Essandoh M. When Are We Going to Address the Lack of Diversity in Cardiothoracic Anesthesiology? J Cardiothorac Vasc Anesth 2021; 35:3148-3149. [PMID: 33602637 DOI: 10.1053/j.jvca.2021.01.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Adam J Milam
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ashley P Oliver
- Department of Anesthesia and Perioperative Medicine, University of California, San Francisco, San Francisco, CA
| | - Stewart A Smith
- Department of Anesthesia and Perioperative Medicine, University of California, San Francisco, San Francisco, CA
| | - TomMario Davis
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
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Williams SC, Milam AJ, Furr-Holden CDM, Salgado CC. Measurement of Social Processes at the Neighborhood Level in Baltimore City. Am J Community Psychol 2020; 66:53-64. [PMID: 32338382 DOI: 10.1002/ajcp.12424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Small-area ecological research is critical to inform place-based interventions at the neighborhood level; however, objective measurement of the social context has been limited. The current study extends the application of the Neighborhood Inventory for Environmental Typology (NIfETy) through the development and evaluation of measures of social context for a longer period of observation (3 years) and at a larger area of aggregation (census tract clusters) compared to previous studies using measures at the block-face level from a single observation. Observations from the 172-item inventory were collected from a random sample of block faces (n = 793) in Baltimore City annually over a three-year period. Through a multistep process including replication of previous measures, data reduction, and factor analysis, six unique neighborhood-level indices were generated to describe the environmental context: drug and alcohol use, violence, physical disorder, epicenter, youth activity, and improvements. An assessment of measurement consistency and validity provided support for some indices, while others had notable limitations. These indices can assist local policymakers and public health practitioners assessing the needs of individual neighborhoods and evaluating the effectiveness of place-based interventions designed to improve the neighborhood environment and population health outcomes.
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Affiliation(s)
- Stacey C Williams
- Johns Hopkins University Bloomberg School of Public Health, Flint, MI, USA
| | - Adam J Milam
- Johns Hopkins University Bloomberg School of Public Health, Flint, MI, USA
| | - C Debra M Furr-Holden
- Michigan State University College of Human Medicine, Division of Public Health, Baltimore, MD, USA
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Lam PH, Milam AJ, Tou E, Dhillon NK, Toscano S, Abaalkhail N. Characteristics of mechanically ventilated patients with COVID-19 and persons under investigation negative for COVID-19 at an academic medical center: A retrospective cross-sectional pilot study. J Clin Anesth 2020; 67:110029. [PMID: 32858344 PMCID: PMC7430259 DOI: 10.1016/j.jclinane.2020.110029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/04/2020] [Accepted: 08/15/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Patrick H Lam
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States of America.
| | - Adam J Milam
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States of America; College of Human Medicine, Michigan State University, Flint, MI 48502, United States of America.
| | - Emiley Tou
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States of America.
| | - Navpreet K Dhillon
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States of America.
| | - Samantha Toscano
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States of America.
| | - Nawaf Abaalkhail
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States of America.
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Barajas CB, Jones SCT, Milam AJ, Thorpe RJ, Gaskin DJ, LaVeist TA, Furr-Holden CDM. Coping, Discrimination, and Physical Health Conditions Among Predominantly Poor, Urban African Americans: Implications for Community-Level Health Services. J Community Health 2020; 44:954-962. [PMID: 30915675 DOI: 10.1007/s10900-019-00650-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
African Americans and ethnic minorities experience racial discrimination in a variety of settings. Racial discrimination is a potent stressor that has been linked to psychosocial stress and poor physical health. To cope with discriminatory experiences and daily life event stressors, African Americans frequently use the concept of John Henryism (a high effort coping strategy with prolonged exposure to stress). This cross-sectional analysis explored the relationship between racism/discrimination, John Henryism, and health problems in a predominately African American sample. Data were collected through health care screenings for hypertension, diabetes, and obesity and a self-report survey to assess experiences of discrimination and use of John Henryism. Logistic and linear regression models were used to assess the relationship between the John Henryism score, racism/discrimination score, and health problems among 352 participants. John Henryism was associated with a decrease in systolic blood pressure (b = - 12.50, 95% CI = - 23.05, - 1.95) among men, after adjusting for experiences of racism/discrimination and demographic characteristics. Experiences of racism/discrimination were associated with an increase in systolic blood pressure (b = 11.23, 95% CI = 0.38, 22.09) among men, after adjusting for John Henryism and demographic characteristics. Among women, there was no association found between John Henryism and experiences of racism/discrimination with systolic blood pressure. No association was found between John Henryism and experiences of racism/discrimination with being overweight/obese in women nor men. The study found that John Henryism was positively associated with the health of men, while experiences of racism/discrimination were negatively associated with their health. Limitations of the study are discussed, and recommendations are made to guide future research exploring the concept of John Henryism as a relevant factor between stress, racial discrimination and poor health.
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Affiliation(s)
- Clara B Barajas
- Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA
| | - Shawn C T Jones
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | - Adam J Milam
- Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA. .,The Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Roland J Thorpe
- The Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Darrell J Gaskin
- The Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Thomas A LaVeist
- The Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.,Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - C Debra M Furr-Holden
- Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA. .,The Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
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Williams SC, Barajas CB, Milam AJ, Olson L, Leaf P, Connolly F. Preparing Students for Success: Differential Outcomes by Preschool Experience in Baltimore City, Maryland. Prev Sci 2020; 21:467-476. [PMID: 31883063 PMCID: PMC7166150 DOI: 10.1007/s11121-019-01069-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
An early adopter of public preschool (i.e., pre-kindergarten, "pre-k"), evidence from Baltimore City, Maryland, can provide insight for those working to improve access to early education opportunities. We followed a cohort of children entering kindergarten in Baltimore City Public Schools during the 2007-2008 year through the 2010-2011 academic year. Students were grouped by pre-k experience: public pre-k (n = 2828), Head Start (n = 839), Head Start plus public pre-k (n = 247), private pre-k (n = 993), or informal care (n = 975). After adjusting for individual- and school-level characteristics, students from the Head Start plus public pre-k group were the most likely to enter kindergarten with the foundational skills and behaviors needed to be successful (vs. all groups, P ≤ .001). Students in informal care were the least likely to enter kindergarten with this skillset (vs. all pre-k groups P ≤ .001). Children from informal care were also significantly more likely than all other groups to be chronically absent in kindergarten (P ≤ .001). By third grade, children from informal care were least likely to be reading on grade level and most likely to have been retained a grade (vs. all pre-k groups P ≤ .001). Children from disadvantaged populations who were not enrolled in pre-k faced significant difficulties keeping up with their peers throughout elementary school; interventions to improve their transition to school and increase their likelihood of academic success are warranted. Universal preschool is likely to improve education outcomes for children in urban areas.
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Affiliation(s)
- Stacey C Williams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Clara B Barajas
- College of Human Medicine, Division of Public Health, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA
| | - Adam J Milam
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
- College of Human Medicine, Division of Public Health, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA
| | - Linda Olson
- Baltimore Education Research Consortium, 2701 N Charles St, Suite 300, Baltimore, MD, 21218, USA
| | - Philip Leaf
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Faith Connolly
- Baltimore Education Research Consortium, 2701 N Charles St, Suite 300, Baltimore, MD, 21218, USA
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Milam AJ, Ghoddoussi F, Lucaj J, Narreddy S, Kumar N, Reddy V, Hakim J, Krishnan SH. Comparing the Mutual Interchangeability of ECOM, FloTrac/Vigileo, 3D-TEE, and ITD-PAC Cardiac Output Measuring Systems in Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2020; 35:514-529. [PMID: 32622708 DOI: 10.1053/j.jvca.2020.03.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of this study was to compare the mutual interchangeability of 4 cardiac output measuring devices by comparing their accuracy, precision, and trending ability. DESIGN A single-center prospective observational study. DESIGN Nonuniversity teaching hospital, single center. PARTICIPANTS Forty-four consecutive patients scheduled for elective, nonemergent coronary artery bypass grafting (CABG). INTERVENTIONS The cardiac output was measured for each participant using 4 methods: intermittent thermodilution via pulmonary artery catheter (ITD-PAC), Endotracheal Cardiac Output Monitor (ECOM), FloTrac/Vigileo System (FLOTRAC), and 3-dimensional transesophageal echocardiography (3D-TEE). MEASUREMENTS AND MAIN RESULTS Measurements were performed simultaneously at 5 time points: presternotomy, poststernotomy, before cardiopulmonary bypass, after cardiopulmonary bypass, and after sternal closure. A series of statistical and comparison analyses including ANOVA, Pearson correlation, Bland-Altman plots, quadrant plots, and polar plots were performed, and inherent precision for each method and percent errors for mutual interchangeability were calculated. For the 6 two-by-two comparisons of the methods, the Pearson correlation coefficients (r), the percentage errors (% error), and concordance ratios (CR) were as follows: ECOM_versus_ITD-PAC (r = 0.611, % error = 53%, CR = 75%); FLOTRAC_versus_ITD-PAC (r = 0.676, % error = 49%, CR = 77%); 3D-TEE versus ITD-PAC (r = 0.538, % error = 64%, CR = 67%); FLOTRAC_versus_ECOM (r = 0.627, % error = 51%, CR = 75%); 3D-TEE_versus ECOM (r = 0.423, % error = 70%, CR = 60%), and 3D-TEE_versus_FLOTRAC (r = 0.602, % error = 59%, CR = 61%). CONCLUSIONS Based on the recommended statistical measures of interchangeability, ECOM, FLOTRAC, and 3D-TEE are not interchangeable with each other or to the reference standard invasive ITD-PAC method in patients undergoing nonemergent cardiac bypass surgery. Despite the negative result in this study and the majority of previous studies, these less-invasive methods of CO have continued to be used in the hemodynamic management of patients. Each device has its own distinct technical features and inherent limitations; it is clear that no single device can be used universally for all patients. Therefore, different methods or devices should be chosen based on individual patient conditions, including the degree of invasiveness, measurement performance, and the ability to provide real-time, continuous CO readings.
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Affiliation(s)
- Adam J Milam
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Farhad Ghoddoussi
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI
| | - Jon Lucaj
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Spurthy Narreddy
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Nakul Kumar
- Department of Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Vennela Reddy
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Joffer Hakim
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Sandeep H Krishnan
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI.
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Milam AJ, Furr-Holden D, Edwards-Johnson J, Webb B, Patton JW, Ezekwemba NC, Porter L, Davis T, Chukwurah M, Webb AJ, Simon K, Franck G, Anthony J, Onuoha G, Brown IM, Carson JT, Stephens BC. Are Clinicians Contributing to Excess African American COVID-19 Deaths? Unbeknownst to Them, They May Be. Health Equity 2020; 4:139-141. [PMID: 32368712 PMCID: PMC7194321 DOI: 10.1089/heq.2020.0015] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
African Americans are overrepresented among reported coronavirus disease 2019 (COVID-19) cases and deaths. There are a multitude of factors that may explain the African American disparity in COVID-19 outcomes, including higher rates of comorbidities. While individual-level factors predictably contribute to disparate COVID-19 outcomes, systematic and structural factors have not yet been reported. It stands to reason that implicit biases may fuel the racial disparity in COVID-19 outcomes. To address this racial disparity, we must apply a health equity lens and disaggregate data explicitly for African Americans, as well as other populations at risk for biased treatment in the health-care system.
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Affiliation(s)
- Adam J. Milam
- Michigan State University College of Human Medicine, Flint, Michigan, USA
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Debra Furr-Holden
- Michigan State University College of Human Medicine, Flint, Michigan, USA
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Birgete Webb
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - John W. Patton
- Stanford University School of Medicine, Stanford, California, USA
| | | | - Lekiesha Porter
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - TomMario Davis
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | - Kevin Simon
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Geden Franck
- Memorial Hermann Health System, Houston, Texas, USA
| | | | | | - Italo M. Brown
- Stanford University School of Medicine, Stanford, California, USA
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Reboussin BA, Furr-Holden DM, Green KM, Ialongo NS, Rabinowitz JA, Matson PA, Maher B, Nelson V, Milam AJ. Social Influences on Drinking Trajectories From Adolescence to Young Adulthood in an Urban Minority Sample. J Stud Alcohol Drugs 2020. [PMID: 31014463 DOI: 10.15288/jsad.2019.80.186] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Research on the heterogeneity in drinking patterns of urban minorities within a socioecological framework is rare. The purpose of this study was to explore multiple, distinct patterns of drinking from adolescence to young adulthood in a sample of urban minority youth and to examine the influence of neighborhood, family, and peers on these trajectories. METHOD Data are from a longitudinal study of 584 (56% male) primarily Black (87%) youth who were first sampled in childhood based on their residence in low-income neighborhoods in Baltimore City and followed up annually through age 26. Data were analyzed using group-based trajectory modeling and multinomial logistic regression. RESULTS Modeling revealed six trajectories from ages 14 to 26: abstainer, experimenter, adult increasing, young adult increasing, adolescent limited, and adolescent increasing. Neighborhood disadvantage was a risk factor for drinking regardless of the timing of onset. Perceptions of availability, peer drinking, and parental approval for drinking were risk factors for underage drinking trajectories, whereas parental supervision was a significant protective factor. Positive social activities in neighborhoods was protective against increased drinking, whereas a decline in perceptions of peer drinking was associated with adolescent-limited drinking. CONCLUSIONS Our findings uniquely highlight the importance of developing interventions involving parents for urban minority youth for whom family is particularly relevant in deterring underage drinking. Perhaps most importantly, our data suggest that interventions that support positive social activities in disadvantaged neighborhoods are protective against adolescent drinking and altering perceptions of peer drinking may reduce adolescent drinking among low-income, urban minority youth.
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Affiliation(s)
- Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Debra M Furr-Holden
- Public Health Division and Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, Flint, Michigan
| | - Kerry M Green
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, Maryland
| | - Nicholas S Ialongo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Pamela A Matson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Victoria Nelson
- Public Health Division and Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, Flint, Michigan
| | - Adam J Milam
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Trangenstein PJ, Greene N, Eck RH, Milam AJ, Furr-Holden CD, Jernigan DH. Alcohol Advertising and Violence. Am J Prev Med 2020; 58:343-351. [PMID: 31980304 PMCID: PMC7140760 DOI: 10.1016/j.amepre.2019.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Numerous studies have found associations between alcohol outlet density and violence, but it is unknown whether alcohol advertisements visible outside outlets are also associated with violent crime. Baltimore City, MD enacted restrictions on retail alcohol establishment advertising practices as of June 5, 2017. This study examines the association between alcohol advertisements visible outside off-premise alcohol outlets and violent crime before this restriction. METHODS Outlet observations (n=683) were conducted in summer 2015, and violent crime data (n=24,085) were from June 5, 2015, through June 4, 2017. The number of violent crimes per square mile within 1,000 feet of outlets was summed using kernel density estimation. In 2018-2019, authors used mixed models with a Simes-Benjamini-Hochberg correction for multiple testing. RESULTS Roughly half (47%, n=267) of the outlets with complete data (n=572) had alcohol advertisements visible from the exterior. Outlets with alcohol advertisements had 15% more violent crimes per square mile within 1,000 feet (eβ=1.15, 95% CI=1.07, 1.25, q<0.001) after adjusting for neighborhood context. All associations between alcohol advertisements and specific types of violent crime were significant, with the association strongest for homicides (eβ=1.28, 95% CI=1.13, 1.46, q<0.001). There was no association between cigarette advertisements and violent crime (eB=1.08, 95% CI=0.92, 1.26, q=0.43). CONCLUSIONS Alcohol advertisements visible outside off-premise outlets were associated with increased violent crime over and above the association between the outlets themselves and violent crime. Reducing alcohol advertising visible from the street may decrease risk of violent crime that is associated with alcohol outlets.
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Affiliation(s)
- Pamela J Trangenstein
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts.
| | - Naomi Greene
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Adam J Milam
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Michigan State University College of Human Medicine, Flint, Michigan
| | - C Debra Furr-Holden
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Michigan State University College of Human Medicine, Flint, Michigan
| | - David H Jernigan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
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Trangenstein PJ, Eck RH, Lu Y, Webster D, Jennings JM, Latkin C, Milam AJ, Furr-Holden D, Jernigan DH. The Violence Prevention Potential of Reducing Alcohol Outlet Access in Baltimore, Maryland. J Stud Alcohol Drugs 2020; 81:24-33. [PMID: 32048598 PMCID: PMC7024813 DOI: 10.15288/jsad.2020.81.24] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 08/30/2019] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE There are few cost-effectiveness analyses that model alcohol outlet zoning policies. This study determines the potential decreases in homicides, disability-adjusted life years (DALYs), and victim and criminal justice costs associated with four policy options that would reduce the alcohol outlet access in Baltimore. METHOD This cost-effectiveness analysis used associations between on-premise (incidence rate ratio [IRR] = 1.41), off-premise (IRR = 1.76), and combined on- and off-premise outlet density (IRR = 1.07) and homicide in Baltimore. We determined the potential change in the level of homicide that could occur with changes in the density of alcohol outlets, assuming that 50% of the association was causal. RESULTS Reducing alcohol outlet density in Baltimore City by one quintile was associated with decreases of 51 homicides per year, $63.7 million, and 764 DALYs. Removing liquor stores in residential zones was associated with 22 fewer homicides, which would cost $27.5 million and lead to 391 DALYs. Removing bars/taverns operating as liquor stores was associated with a decrease of one homicide, $1.2 million, and 17 DALYs. Removing both the liquor stores in residential zones and the bars/taverns operating as liquor stores was associated with 23 fewer homicides, which translated to $28.7 million and 409 DALYs. CONCLUSIONS For preventing homicides, the strategy of removing liquor stores in residential zones was preferred because it was associated with substantial reductions in homicides without closing unacceptably high numbers of outlets. It is possible that policies that close the bars/taverns operating as liquor stores would be associated with decreases in other types of violent crime.
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Affiliation(s)
- Pamela J. Trangenstein
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | | | - Yi Lu
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Daniel Webster
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Adam J. Milam
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Debra Furr-Holden
- Michigan State University College of Human Medicine, Flint, Michigan
| | - David H. Jernigan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
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Milam AJ, Barajas CB, Buchalski Z, Wang L, Sadler RC, Furr-Holden CDM. Discrepancies in Local, State, and National Alcohol Outlet Listings: Implications for Research and Interventions. Subst Use Misuse 2020; 55:2348-2356. [PMID: 32917123 PMCID: PMC7644371 DOI: 10.1080/10826084.2020.1817080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The availability of local, state, and national data on alcohol outlet density have important implications for policies and interventions aiming to reduce alcohol-related problems. High-quality data on locations of alcohol outlets is important to accurately inform community interventions and public health initiatives, but such data is often not maintained, readily available, or of sufficient quality. Objectives: This study aims to examine the discrepancies between alcohol outlet databases and how neighborhood characteristics (i.e. income, majority racial population, urbanicity) are associated with the discrepancies between databases. Methods: Data was collected from national (n = 1), local (n = 2), and state databases (n = 3). Negative binomial regression models were used to assess discrepancies in alcohol outlet count at the ZIP code level based on the data source. Results: The average density of alcohol outlets (per 1000 residents) ranged from 0.71 to 2.17 in Maryland, 1.65 to 5.17 in Wisconsin, and 1.09 to 1.22 in Oregon based on different sources of data. Findings suggest high income areas (>200% poverty level) have fewer discrepancies (IR = 0.775, p < 0.01), low income areas (below poverty level) have greater discrepancies (IR = 4.990, p < 0.01), and urban areas tend to have fewer discrepancies (IR = 0.378, p < 0.01) between datasets. Conclusion: Interventions and policies depend on valid and reliable data; researchers, policymakers, and local agencies need to collaborate to develop methods to maintain accurate and accessible data.
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Affiliation(s)
- Adam J Milam
- College of Human Medicine Division of Public Health, Michigan State University, Flint, Michigan, USA.,Bloomberg School of Public Health, Department of Mental Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Clara B Barajas
- College of Human Medicine Division of Public Health, Michigan State University, Flint, Michigan, USA
| | - Zachary Buchalski
- College of Human Medicine Division of Public Health, Michigan State University, Flint, Michigan, USA
| | - Ling Wang
- College of Human Medicine Department of Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Richard C Sadler
- Department of Family Medicine, College of Human Medicine Division of Public Health, Michigan State University, Flint, Michigan, USA
| | - C Debra M Furr-Holden
- College of Human Medicine Division of Public Health, Michigan State University, Flint, Michigan, USA.,Bloomberg School of Public Health, Department of Mental Health, Johns Hopkins University, Baltimore, Maryland, USA
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Powell TW, Rabinowitz JA, Kaufman MR, Milam AJ, Benke K, Sisto DY, Uhl G, Maher BS, Ialongo NS. Testing gene by community disadvantage moderation of sexual health outcomes among urban women. PLoS One 2019; 14:e0223311. [PMID: 31581256 PMCID: PMC6776350 DOI: 10.1371/journal.pone.0223311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 09/05/2019] [Indexed: 11/19/2022] Open
Abstract
We examined whether the interplay between community disadvantage and a conduct disorder polygenic risk score (CD PRS) was associated with sexual health outcomes among urban women. Participants (N = 511; 75.5% African American) were originally recruited to participate in a school-based intervention and were followed into adulthood. Community disadvantage was calculated using census data when participants were in first grade. At age 20, blood or saliva samples were collected and participants reported on their condom use, sexual partners, and sexually transmitted infections. A CD PRS was created based on a genome-wide association study conducted by Dick et al. [2010]. Higher levels of community disadvantage was associated with greater sexually transmitted infections among women with a higher CD PRS. Implications of the study findings are discussed.
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Affiliation(s)
- Terrinieka W. Powell
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jill A. Rabinowitz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Michelle R. Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Adam J. Milam
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Kelly Benke
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Danielle Y. Sisto
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - George Uhl
- New Mexico VA HealthCare System, Las Vegas, NM, United States of America
| | - Brion S. Maher
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Nicholas S. Ialongo
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Jones SCT, Brooks JH, Milam AJ, Barajas CB, LaVeist TA, Kane E, Furr-Holden CDM. Racial discrimination, John Henryism coping, and behavioral health conditions among predominantly poor, urban African Americans: Implications for community-level opioid problems and mental health services. J Community Psychol 2019; 47:1032-1042. [PMID: 30791117 PMCID: PMC6581591 DOI: 10.1002/jcop.22168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 05/10/2023]
Abstract
The current study examined the relationship between John Henryism Active Coping (JHAC), experiences of racial discrimination, and behavioral health outcomes in a community sample of 319 Black adults. Assessments included primary health care screenings as well as self-reported survey questions to assess JHAC, experiences of discrimination, and self-reported behavioral health. Logistic regression models, adjusted for control variables, found a significant relationship between JHAC and having an opioid problem (odds ratio [OR] = 0.95, p = 0.003) and needing mental health services (OR = 0.95, p < 0.001), such that higher levels of coping were associated with lower odds of reporting an opioid problem and needing mental health services. Notably, racial discrimination was not significantly independently associated with behavioral health. Implications for interventions and community programming are discussed.
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Affiliation(s)
| | | | - Adam J Milam
- Michigan State University
- Johns Hopkins University
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Reboussin BA, Furr-Holden DM, Green KM, Ialongo NS, Rabinowitz JA, Matson PA, Maher B, Nelson V, Milam AJ. Social Influences on Drinking Trajectories From Adolescence to Young Adulthood in an Urban Minority Sample. J Stud Alcohol Drugs 2019; 80:186-195. [PMID: 31014463 PMCID: PMC6489548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 12/18/2018] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVE Research on the heterogeneity in drinking patterns of urban minorities within a socioecological framework is rare. The purpose of this study was to explore multiple, distinct patterns of drinking from adolescence to young adulthood in a sample of urban minority youth and to examine the influence of neighborhood, family, and peers on these trajectories. METHOD Data are from a longitudinal study of 584 (56% male) primarily Black (87%) youth who were first sampled in childhood based on their residence in low-income neighborhoods in Baltimore City and followed up annually through age 26. Data were analyzed using group-based trajectory modeling and multinomial logistic regression. RESULTS Modeling revealed six trajectories from ages 14 to 26: abstainer, experimenter, adult increasing, young adult increasing, adolescent limited, and adolescent increasing. Neighborhood disadvantage was a risk factor for drinking regardless of the timing of onset. Perceptions of availability, peer drinking, and parental approval for drinking were risk factors for underage drinking trajectories, whereas parental supervision was a significant protective factor. Positive social activities in neighborhoods was protective against increased drinking, whereas a decline in perceptions of peer drinking was associated with adolescent-limited drinking. CONCLUSIONS Our findings uniquely highlight the importance of developing interventions involving parents for urban minority youth for whom family is particularly relevant in deterring underage drinking. Perhaps most importantly, our data suggest that interventions that support positive social activities in disadvantaged neighborhoods are protective against adolescent drinking and altering perceptions of peer drinking may reduce adolescent drinking among low-income, urban minority youth.
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Affiliation(s)
- Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Debra M. Furr-Holden
- Public Health Division and Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, Flint, Michigan
| | - Kerry M. Green
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, Maryland
| | - Nicholas S. Ialongo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jill A. Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Pamela A. Matson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Victoria Nelson
- Public Health Division and Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, Flint, Michigan
| | - Adam J. Milam
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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50
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Reboussin BA, Ialongo NS, Green KM, Furr-Holden DM, Johnson RM, Milam AJ. The Impact of the Urban Neighborhood Environment on Marijuana Trajectories During Emerging Adulthood. Prev Sci 2019; 20:270-279. [PMID: 29845401 PMCID: PMC6265122 DOI: 10.1007/s11121-018-0915-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although there is little difference in rates of marijuana use between White and Black youth, Blacks have significantly higher rates of marijuana use and disorder in young adulthood. Theory suggests that factors tied to social disadvantage may explain this disparity, and neighborhood setting may be a key exposure. This study sought to identify trajectories of marijuana use in an urban sample during emerging adulthood, neighborhood contexts that predict these trajectories and social role transitions or "turning points" that may redirect them. Data are from a longitudinal cohort study of 378 primarily Black emerging adults who were first sampled in childhood based on their residence in low-income neighborhoods in Baltimore City and followed up annually. Group-based trajectory modeling identified three groups: No Use (68.8%), Declining Use (19.6%), and Chronic Use (11.7%). Living in close proximity to an alcohol outlet, and living in a neighborhood with more female-headed households and higher rates of violent crime increased the odds of membership in the Chronic Use group relative to No Use. Living in a neighborhood with more positive social activity increased the odds of membership in the Declining Use group relative to No Use. Not receiving a high school diploma or GED, pregnancy, and parenting also increased the odds of membership in the Declining Use group relative to No Use. These findings provide support that minority youth living in socially toxic and disordered neighborhoods are at increased risk of continuing on a trajectory of marijuana use during emerging adulthood while positive social activity in neighborhoods has the potential to redirect these negative trajectories. Besides taking on the responsibilities of parenting, emerging adults in the marijuana user groups had similar educational and family outcomes, suggesting that early marijuana use may have long-term implications.
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Affiliation(s)
- Beth A Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
| | - Nicholas S Ialongo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Kerry M Green
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD, 20742, USA
| | - Debra M Furr-Holden
- Public Health Division and Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, Flint, MI, 48502, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Adam J Milam
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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